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Labour, step by step

This is it. You've got the baby's bedroom decorated. You've applied for a season ticket and made a provisional application for a place on the football training course at the local club. Now there's just the small matter of the birth. Hmm. Read on...

Is she in labour? How to tell.

Game on? Or false alarm? The real signs are hard to mistake. Here's what to look out for.

Nesting

It's 3 am and she wants to get up and finish painting the baby's bedroom. It's just an overwhelming feeling that she has to get everything ready as soon as possible.

Crying

You should be used to this after nine months. But her hormones will be working extra overtime now, so expect her to be totally unreasonable, let her be totally unreasonable, smile sweetly and make her a cup of tea. What she's about to go through is unreasonable, so cut her some slack.

Contractions

She might have had a few 'false' (Braxton Hicks') contractions already, but she'll know the difference between these and the real thing. Get the stopwatch out and time them. When they're regular and last more than 30 seconds it's probably the real deal.

No, she hasn't lost control of her bladder

The famous 'waters breaking' is when the womb sac containing the amniotic fluid bursts (this is the stuff Baby's been swimming in). The hospital will want to know all the gory details so take notes - when? Was it a trickle or a gush? Was it an egg cup-full or a coffee cup-full? Was it pale or were there any green bits in it? Did it smell? (it shouldn't).

It's the real thing. But don't panic.

It's not all going to happen in a rush the moment she begins labour. It starts slowly and then speeds up. There are three stages:

One - Baby needs an escape route. Contractions open up the cervix - at the top of the vagina, which now becomes the 'birth canal'.

Two - Baby makes an appearance - the actual birth.

Three - the 'afterbirth', in which the placenta is expelled (this is what's been keeping Baby supplied with the necessaries).

FIRST STAGE

Top tips for the early stage

The best thing you can do right now is run her a bath, put on some music, fuss around her and relax for half an hour. Both of you. Even at 3 am.

Make sure she keeps busy. Best not to re-arrange heavy furniture, but normal light household stuff is fine. She'll probably feel like keeping a bit of routine going - it's comforting and won't do any harm.

When to go to the hospital

Before you go, call the labour ward and tell the duty midwife what's been happening. It might still be too early and it's better to be bored at home than in the hospital. Signs that it's time to go are:

Her waters have broken, especially if it caused a minor flood.

Her contractions are regular and strong, about 5 minutes apart and lasting about 60 seconds.

Take the journey into account - if it's likely to take a long time, leave earlier than if the hospital is within walking distance.

Remember - second and subsequent babies come more quickly.

Strong labour

She's well on the way. Her cervix has opened to around 5 cm, her contractions are more frequent, longer and stronger. You're now in best supporting role -here are a few things you can do to help.

Let her hang on to you - standing with her arms round your shoulders.

Put your earplugs in and encourage her to shout at you. After all, this is all your fault.

Give her a back-rub if she wants it. And stand well back if she doesn't, some women can't stand being touched at this stage.

Pain relief

This is where the pain relief options kick in. If you've been to ante-natal classes you'll have learned all about them and will have discussed what she wants and doesn't before now. Here's a run-down of the options.

Gas and air (Entonox, or laughing gas) doesn't actually stop pain but she'll find it easier to deal with, a bit like being tipsy. It's very safe and she can take gulps of it when she feels like it without asking anyone medical.

TENS is a clever electrical gizmo that stimulates the body's own natural painkillers with a small electric current and can be turned up or down as needed.

Pethidine is a strong painkiller given by injection. It will help her relax as well, but could make her feel dizzy and may make baby tired and slow to respond.

An epidural is the gold standard of painkillers. It's a spinal injection that numbs the body from the waist down. The down-side is that it can increase the length of labour and she is more likely to need an assisted delivery.

Wired up

Sometimes they like to know how the baby is doing and the easiest way to find out is to monitor the heartbeat. She'll be wired up to various machines for this and it's nothing to be worried about. It's normal and doesn't mean there's a problem.

Don't push

You've seen it on hospital soaps - the midwife telling her not to push when that's all she wants to do. This is because the cervix isn't fully open yet and she can't push the baby out. This is when things get really tough, so brace yourself for some ripe language and do whatever it is she needs you to.

She might decide it was all a ghastly mistake and she wants a recount. That's if you're lucky. She could also be using words you didn't think she knew and it will all be directed at you. Be brave, wash her face, rub her hands and feet, tell her how well she's doing, help her with her breathing (aren't you glad now that you went to ante-natal classes?)

SECOND STAGE

The cervix is fully open and your baby has started to move through the birth canal. Baby is heading your way!

Top tips for helping her during the birth

She might well find that trying different positions can help - sitting on the bed, kneeling with arms and shoulders on pillows draped over the end of the bed, kneeling on the floor. Be ready to help make her as comfortable as possible.

When Baby's head has appeared, the midwife will make sure she stops pushing. This is so the head can emerge slowly, giving her skin and muscles time to stretch without tearing. Panting rather than breathing is what she has to do and you can help by pacing her.

You'll see the top of Baby's head - a brilliant moment - and telling her what you can see is a great way of encouraging her.

Episiotomy

If the skin and muscles of the perineum - the area between the vagina and the anus - aren't stretching enough there's a risk it will tear. To avoid this happening, the midwife will ask permission to perform an episiotomy. This is a small cut made under local anaesthetic in the perineum and it's much better than a tear. It's perfectly routine and neither of you really has to think about whether to say yes. With care and attention to basic hygiene, the cut will heal quite quickly and leave no lasting effects.

Head's out. What about the rest?

Once Baby's head is out (check your watch and note the time for future reference), most of the hard work is done and with one more push the rest of the body is born. You'll probably be a bit teary, but it's just something in your eye, honest.

Baby will be a bit messy, but don't be alarmed. There will be blood and white, greasy stuff called vernix (think workshop barrier cream).

Most mums want their baby lifted on to their tummy to hold and cuddle straightaway.

The cord will be cut, any mucus in Baby's nose and mouth will be cleared and you'll hear for the first time a strange crying noise that you'll become very, very familiar with in the weeks to come.

Introduce yourself. Baby already knows your voice and has been wondering what you look like.

THIRD STAGE

A few more contractions and the placenta will be pushed out. This can take anything up to an hour and if it's going too slowly the midwife might give her an injection to speed it up.